Provider Demographics
NPI:1396853875
Name:NUGENT, MICHAEL RONNIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RONNIE
Last Name:NUGENT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 BURKE RD STE A
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1800
Mailing Address - Country:US
Mailing Address - Phone:713-941-8261
Mailing Address - Fax:713-941-4766
Practice Address - Street 1:3421 BURKE RD STE A
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1800
Practice Address - Country:US
Practice Address - Phone:713-941-8261
Practice Address - Fax:713-941-4766
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22464122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist